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What is endometriosis?

Endometriosis is a condition in which cells similar to the endometrium (the tissue that lines the uterus) grow outside of the uterus. It is estimated that endometriosis affects between 2 to 10 percent of U.S. women between the ages of 25 to 40. An often painful condition, endometriosis can affect patients from head to toe, often causing symptoms like intense menstrual cramps, heavy menstrual bleeding, painful sex, and infertility.

What happens in a patient’s body when they have endometriosis?

Over the course of a patient’s menstrual cycle, the tissues that line their uterus build up, then break down, and finally shed if the patient does not become pregnant. When endometriosis causes similar tissue to grow outside of the uterus, in the ovaries, fallopian tubes, and/or on the pelvic tissues surrounding the uterus, these tissues behave in the same way as the endometrium. They thicken, break down, and shed, but because there is no way for them to leave the body, they cause bleeding and inflammation within the pelvis. This leads to swelling and the development of scar tissue inside the pelvic area or between the pelvic tissues and organs. 

What are the symptoms of endometriosis?

The  most commonly reported symptoms of endometriosis include:

  • Pelvic pain, especially during periods
  • Painful menstrual cramps that may worsen over time
  • Heavy menstrual flow
  • Painful sex
  • Infertility
  • Bleeding or spotting between periods
  • Pain with bowel movements and/or urination during periods
  • Bloating, nausea, diarrhea, and/or constipation

Some patients may have no symptoms at all, and may have an incidental diagnosis of endometriosis that is found on imaging or during surgery.

What causes endometriosis?

The cause of endometriosis is still unknown, but experts have proposed and continue to study several possible causes, including:

  • Retrograde menstrual flow, which occurs when some of the tissues that are shed during menstruation travel through the fallopian tubes and back toward the pelvic organs instead of flowing out of the body. 
  • The transformation of embryonic cells or peritoneal cells (the cells of the inner abdomen) into cells like those of the endometrium.
  • The accidental movement of endometrial cells to other tissues during a surgery like a Cesarean section (C-section) or hysterectomy.
  • The transportation of endometrial tissue to other locations in the body through the blood vessels or lymphatic system.
  • A problem with the body’s immune system that leaves it more susceptible to endometrial-like tissue growing outside of the uterus.

How might endometriosis impact an individual’s sex life?

About two-thirds of patients with endometriosis report experiencing at least one sexual issue. Most often, the issue is dyspareunia, also known as painful intercourse. This experience varies greatly from person-to-person because it depends on where the endometriosis is located and the severity of the condition. For example, endometriosis located in the lower uterus or near the vagina may cause more painful penetration due to its proximity to the penetrating object.

Some patients have pain during intercourse, while others have pain only after intercourse. The type of pain also varies among patients and has been described as mild, sharp, stabbing, deep, and/or aching.

Understandably, when a person has had a painful experience with sex, they may feel more anxious to have sex again. This can contribute to feelings of fear, anxiety, and stress related to sex. 

How can endometriosis symptoms be managed for more enjoyable sex?

There is hope for patients with endometriosis when it comes to enjoying sexual activity. Importantly, patients are encouraged to communicate with their sexual partners, especially when an experience is painful or uncomfortable. They can experiment with different positions and other sexual activities to seek safe, comfortable, and enjoyable pleasure. 

If you are seeking medical or surgical options to alleviate symptoms of endometriosis and improve sexual experiences, speak with a healthcare professional.. 


Michael Krychman, MDCM

Dr. Michael Krychman is a Board Certified OBGYN and an AASECT Certified Sexual Counselor and Supervisor. He specializes in menopausal health, hormone therapy, sexual pain disorders, vulvar disorders and loss of libido, chronic medical illness, and medical devices and their impact on female sexual function.

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